NICE outlines pharmacists' role in dyspepsia
Pharmacists should be the first point of contact for people suffering from symptoms of dyspepsia. They should also offer ongoing support, including advice about lifestyle changes, use of over-the-counter medicines, help with prescribed drugs and advice about when to consult a GP.
These are some of the main recommendations of a new National Institute
for Clinical Excellence guideline which sets out how health professionals
should manage the diagnosis, treatment and care of adults with dyspepsia
in primary care.
The guideline, which is directed at pharmacists and GPs working in England
and Wales, recognises that for many people dyspepsia can by managed by
self-care with treatments and advice obtained from a pharmacist. It suggests
that pharmacists record any adverse reactions to treatment and participate
in primary care medication review clinics.
NICE also emphasises that long-term care should promote patient empowerment,
and that treatment strategies should include “on-demand” use
of a low-dose proton pump inhibitor (PPI). NICE also recommends that
patients are reviewed annually and that they are offered the opportunity
to step down or stop treatment where appropriate. Self-treatment with
antacid or alginate therapy (either prescribed or purchased over-the-counter
and taken as required) may be appropriate for many patients,
it states.
Other recommendations include:
· Medicines should be reviewed as possible causes of dyspepsia
· In patients requiring referral for an
endoscopy the use of non-steroidal anti-inflammatory drugs should be
suspended
· Initial therapeutic strategies for dyspepsia are empirical treatment
with a PPI or testing for and treating Helicobacter pylori
Individual strategies are recommended for peptic ulcer disease, non-ulcer
dyspepsia and gastro-oesophageal reflux disease.
A statement issued by the Reflux Forum (an industry-sponsored group comprising
GPs, pharmacists and pharmaceutical advisers) warned that pharmacists
will need to play an ongoing monitoring role if serious conditions are
not to be missed. Bill Sandhu, prescribing adviser for Maidstone Weald
Primary Care Trust, said: “Pharmacists should be encouraged to
work in partnership with patients, allowing them to take responsibility
for making appropriate lifestyle changes, educating them to be aware
of alarm signals and also to re-present if symptoms deteriorate or they
are needing to top up with OTC medicines.”
The guideline is available from the National Electronic Library for Health
website (www.nelh.nhs.uk). Three summary versions — one for patients,
one for health care professionals and a quick reference guide — are
also available here |
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